Department of Internal Medicine, Westchester Medical Center Health Network and New York Medical College, Valhalla, New York, USA.
Division of Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center Health Network and New York Medical College, Valhalla, New York, USA.
Telemed J E Health. 2021 Apr;27(4):388-396. doi: 10.1089/tmj.2020.0232. Epub 2020 Aug 14.
The COVID-19 pandemic poses enormous resource challenges to hospitals. Telemedicine is increasingly recognized as an attractive tool to alleviate resource strains. Herein we describe the rapid implementation and sequential process improvement (PI) of a centralized telehospitalist service to coordinate and optimize management of large number of COVID-19 patients in a tertiary and quaternary care hospital very close to the New York City epicenter. Prospective multidisciplinary PI meetings were held weekly between March 23 and May 10, 2020, and consensus service modifications were implemented for the following week. Inpatient census data, telehospitalist intervention volumes, and service utilization statistics were collected. Between March 23 and May 10, 2020, a total of 745 COVID-19 patients were admitted to the general medical wards. The telehospitalist service performed 1,136 audiovisual (AV) patient assessments, 379 best practice interventions, cohorted 108 patients, and conducted 170 remote family conversations. During the consecutive PI cycles, a number of adaptations in AV setup, care standardization, patient logistics, communication, and consultative functions were made to load balance the bedside hospitalist teams. As the COVID-19 hospital census increased to peak levels, the most value was added through facilitation of communication and collaboration between the bedside clinical teams, the infection prevention and control teams, and patient logistics team. A telehospitalist service can be rapidly implemented with basic telemedicine equipment. Processes/this functions can be sequentially adapted to quickly changing needs during conditions such as the COVID-19 pandemic that very quickly can place extraordinary strains on hospital resources.
COVID-19 大流行给医院带来了巨大的资源挑战。远程医疗越来越被认为是缓解资源紧张的一种有吸引力的工具。在此，我们描述了一种集中式远程医疗服务的快速实施和连续的流程改进（PI），以协调和优化一家位于纽约市震中附近的三级和四级保健医院大量 COVID-19 患者的管理。2020 年 3 月 23 日至 5 月 10 日期间，每周举行一次多学科前瞻性 PI 会议，并为下周实施共识服务修改。收集住院患者人数数据、远程医疗服务人员干预量和服务利用统计数据。2020 年 3 月 23 日至 5 月 10 日，共有 745 名 COVID-19 患者入住普通医疗病房。远程医疗服务人员进行了 1136 次视听（AV）患者评估、379 次最佳实践干预、将 108 名患者分组并进行了 170 次远程家庭谈话。在连续的 PI 周期中，对 AV 设置、护理标准化、患者物流、沟通和咨询功能进行了一些调整，以平衡床边医院医生团队的工作量。随着 COVID-19 医院入住率达到高峰，通过促进床边临床团队、感染预防和控制团队以及患者物流团队之间的沟通和协作，实现了最大的价值。远程医疗服务可以通过基本的远程医疗设备快速实施。在 COVID-19 等情况下，流程/功能可以快速适应不断变化的需求，这些情况会给医院资源带来巨大压力。
